Individual
SIMON KOTLYAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 THREE SPRINGS BLVD, DURANGO, CO 81301-8296
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 17752, DENVER, CO 80217-0752
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
044635
CT
207P00000X
Emergency Medicine Physician
244490-1
NY
207P00000X
Emergency Medicine Physician
Primary
52012
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82735085
—
CO
Enumeration date
06/18/2007
Last updated
03/31/2014
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